Alcohol and drugs strategic plan: Fairer Scotland Duty assessment summary

Summary of evidence

This assessment has been developed alongside the Strategic Plan to support publication in spring 2026. Future iterations will align with the Plan’s rolling three year commitments review. The assessment draws on existing evidence and engagement with Scottish Government policy teams, analytical colleagues, PHS, COSLA, ADPs, and lived and living experience groups.

Evidence shows that alcohol and drug related harms in Scotland are marked by socio‑economic inequalities, with people in the most deprived communities experiencing worse outcomes: the most recent available national data demonstrates that drug deaths are over fifteen times higher^[1] and drug‑related hospital stays around twelve times higher in the most deprived areas;[2] alcohol‑specific mortality is over four times higher[3] and hospital stays more than six times higher.[4]

These inequalities are long‑standing, systemic, and strongly linked to wider social determinants including poverty, trauma, unstable housing, and variation in access to support.[5]^,[6]

The evidence further highlights how multiple forms of disadvantage intersect, compounding risk and worsening outcomes. People experiencing homelessness^[7] and those with current or past justice involvement face particularly acute harms,[8] with a high proportion of deaths involving individuals who have been homeless or in prison. Rural and island communities experience their own distinct inequalities, primarily related to reduced service availability, long travel distances, and higher levels of unmet need for specialist treatment and wider support. People with protected characteristics - including women, minority ethnic groups, LGBTQ+ communities, disabled people, and those with co‑occurring mental health conditions - may also face greater barriers to accessing services, though gaps in disaggregated data limit fuller understanding. Please refer to the EqIA for a further assessment of impacts of the Plan on these groups.

Evidence also heavily suggests that a whole-system approach based on human rights is more likely to deliver better outcomes for those experiencing harm, especially where there are multiple intersecting needs.[9]^,[10]

The evidence therefore points to the need for a rights‑based, whole‑system approach that focuses on prevention, earlier intervention, high‑quality harm reduction, accessible and consistent treatment, and stronger support across housing, mental health, family support and justice transitions. This approach aligns with what has been shown to work during the National Mission^[11] and in wider public health and human rights guidance. It also underscores the importance of improving national data, particularly for protected groups and rural communities, to better understand and reduce inequalities of outcome over time.